Clinical Review

Driving and dementia

BMJ 2007; 334 doi: 10.1136/bmj.39233.585208.55 (Published 28 June 2007)
Cite this as: BMJ 2007;334:1365

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  1. David A Breen, consultant in public health medicine1,
  2. David P Breen, foundation year 2 doctor in combined assessment medicine2,
  3. John W Moore, consultant clinical neuropsychologist1,
  4. Patricia A Breen, staff grade in old age psychiatry1,
  5. Desmond O'Neill, associate professor of medical gerontology3
  1. 1NHS Dumfries and Galloway, Dumfries, Scotland
  2. 2Royal Infirmary of Edinburgh, Edinburgh, Scotland
  3. 3Trinity College, Dublin, Republic of Ireland
  1. Correspondence to: D O'Neill, Department of Medical Gerontology, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Republic of Ireland arhc{at}amnchi.ie
  • Accepted 23 April 2007

Summary points

  • Many people with early dementia are capable of driving safely

  • Evidence suggests that the risk of crashes in drivers with dementia is low for up to three years after disease onset, but this varies between people

  • The Driver and Vehicle Licensing Agency must be notified of all new diagnoses of Alzheimer's disease and other dementias: this relies primarily on self reporting

  • The doctor's role is to make an immediate decision on safety to drive and to ensure that the licensing agency is notified

  • Cognitive testing cannot determine whether individuals with early dementia are able to drive safely

  • The challenge for doctors and the licensing agency is to balance mobility and safety in a growing population of older drivers

Dementia is important in relation to driving. As the disease progresses the ability to drive safely is eventually lost and at that point current regulations demand that driving stops. Many patients continue to drive after dementia has been diagnosed,1 2 3 4 5w10 however, and withdrawal of their licence should not be undertaken lightly. A study highlighted the negative consequences of stopping people with dementia from driving.w11 Stopping driving can limit access to family, friends, and services and is an independent risk factor for entry to a nursing home.w12

Traffic medicine has evolved significantly since the 1990s, with more emphasis on preserving mobility. As populations age and increasing numbers of older people drivew1 general practitioners are key players in ensuring that older people are not constrained by an unfair attribution of risk. Health professionals, however, practise in a society where the perception of older drivers is negative.w2 This may stem from misconceptions about the impact of age related disease on driving: these misunderstandings also apply to medical journals, which commonly reproduce statements on the apparent increase …

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